Cheers Fall 2015

St. Mary-Corwin Medical Center

CELEBRATING YOUR HEALTH

Fall 2015 Volume 5, Number 4

RAPID

RESPONSE Quick thinking and accurate diagnosis can make health emergencies into distant memories.

Story on Page 3

3-D Spine Surgery PAGE 2

Making Dialysis Easier PAGE 4

James West is back to kicking soccer balls after a ruptured spleen, thanks to the fast and accurate work of St. Mary-Corwin’s emergency team.

Healing Wounds Faster PAGE 6

PHOTO BY STEVE BIGLEY

Health Briefs

3-D Spine Surgery

The painful side of pot Marijuana use may make the pain worse after surgery

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ne out of eight Colorado residents reports using marijuana regularly, a 22 percent increase from Colorado’s pre-legalization days, according to the National Survey on Drug Use and Health. Anecdotal evidence at St. Mary-Corwin Medical Center shows that a spike in usage is also increasing pain control issues following surgery.

“In cases where patients are chronic marijuana users either for medical or recreational purposes, we are having a much harder time controlling their pain in the recovery room,” Dr. John Sandoval says John R. Sandoval, MD, chief anesthesiologist at St. Mary-Corwin Medical Center.

Sandoval recalls one patient who underwent a simple procedure, but the minimal amounts of opioids and narcotics generally required after surgery were ineffective in controlling his pain.

“More research about marijuana’s impact on pain control post-surgery and its interactions with opioids and narcotics is needed, but for the cases I’ve consulted on, there appears to be a connection between consistent marijuana use and (more difficult) pain management post-surgery,” he says.

 SUPPORT SPOT

If you suffer from chronic pain, join St. Mary-Corwin’s pain management support group.

During this FREE 14-week program, experts will discuss alternate treatment options available in the community, including acupuncture, massage therapy, nutrition, biofeedback, and many others. For more information, or to reserve your spot, call 719-557-3658. 

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pine patients at St. Mary-Corwin Medical Center now benefit from a new piece of technology known as neurospine navigation. Using 3-D images, neurospine navigation gives surgeons a more precise view of the Dr. Ken Danylchuk patient’s anatomy and the location of instruments and implants during surgery.

“I’ve used similar navigation on knee replacements and spinal surgeries and have been extremely happy with the outcomes,” says Ken Danylchuk, MD, PhD, the only orthopedic surgeon at St. Mary-Corwin Medical Center to utilize NEUROSPINE neurospine navigation. “In addition to NAVIGATION BENEFITS: increased accuracy, it may increase the e I ncreased accuracy of screw efficiency of spinal procedures.” and device placement Neurospine navigation can enhance eB etter visualization of a variety of procedures, including anatomy and surgical spine fusions, spinal revision surgery, instruments and kyphoplasty for spine fractures, eM ay reduce surgery time Danylchuk says.

 FOLLOW UP St. Mary-Corwin physicians offer a wide range of orthopedic treatments. To learn more, go online to stmarycorwin.org. 

SMC steps up sepsis control

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ach year, more than 1 million Americans develop sepsis, a lifethreatening medical condition caused by the body’s overreaction to infection. During sepsis, chemicals and bacteria are released into the blood, restricting blood flow that can lead to organ failure. While people with weakened immune systems are most vulnerable to sepsis, it can affect anyone with an infection.

SIGNS OF SEPSIS CAN INCLUDE: “More attention has been given to sepsis in the past decade, helping reduce the mortality rate from 90 percent to about 60 percent Abnormally high in severe cases today,” says Ashley Cox, a heart rate registered nurse at St. Mary-Corwin Medical Center who recently completed a graduate program research project on sepsis.

Fever The only way to prevent sepsis is to eliminate infection. But to do that, infection has to be identified. So, the key to reducing mortality rates is recognition, says Tana Trujillo, RN, clinical nurse High white blood cell count specialist at St. Mary-Corwin Medical Center, who has helped spearhead a hospital initiative to lower the rate of sepsis. “Intervention is not possible without recognition.”

Low urinary output A sepsis team at St. Mary-Corwin Medical Center helps promote community education and refine internal processes for sepsis Chills recognition and treatment.

ZZ If sepsis is suspected, immediate medical Z attention, including intravenous antibiotics, Lethargy can increase survival rates.

ON THE BALL SPEEDY, thorough emergency evaluation at St. Mary-Corwin Medical Center’s Level III Trauma Center saves soccer player’s spleen

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routine soccer match in May led to unexpected injuries for 15-year-old James West, who was struck in the left side while making a headed clearance. West sat out the remainder of the game, but his shoulder and rib pain kept increasing.

“Once I got home, my pain just kept getting worse, so I knew it had to be more than a bruise,” West says.

West’s father, David, took him to St. Mary-Corwin Medical Center’s ER, a Level III Trauma Center. “We’ve counted on St. Mary-Corwin’s quality care for years,” he says.

GOAL — QUICK, ACCURATE DIAGNOSIS

PHOTO: BALL ©DOLLARPHOTOCLUB.COM/ALEKSS; GRASS ©DOLLARPHOTOCLUB.COM/BEDNAREK; FAMILY BY STEVE BIGLEY

Once at the ER, West was quickly evaluated and sent for X-rays, which ruled out broken bones. Because of West’s symptoms, the ER physician and Teddi Adams, RN, West’s ER nurse, pressed for a CT scan.

“James’ blood pressure kept dropping, he was getting more pale, and he was guarding his left side,” Adams says. “I suspected a spleen injury.”

Thanks to St. Mary-Corwin’s Level III Trauma Center capabilities, West underwent a CT scan within minutes, which showed a fractured (ruptured) spleen.

“The quick action saved James’ life,” Adams says.

West was given fluids, stabilized, and immediately prepped for transfer via Centura Health Flight For Life to Children’s Hospital in Denver. While St. Mary-Corwin Medical Center could have managed his care, the trauma surgeon recommended transfer due to his young age.

“St. Mary-Corwin’s friendly doctors and nurses kept us informed every step of the way,” says West’s mother, Debbie.

BACK IN THE GAME St. Mary-Corwin Medical Center’s trauma capabilities saved both West’s spleen and soccer career. The entire process from walking into the ER until when West was flown to Denver happened in under an hour, say his parents. West’s spleen clotted, eliminating the need for surgery, and he went home after three days of bed rest. He was cleared to play soccer at the end of July.

“This is one example of the timely trauma care we’re able to provide here at St. Mary-Corwin,” says Patrick Stanifer, director of emergency services. “We can handle most any type of trauma.”

As a Level III Trauma Center, St. Mary-Corwin Medical Center offers state-of-the-art technology; on-site imaging; 24-hour emergency coverage by trauma-trained nurses, physicians, surgeons, and anesthesiologists; and specialties, including neurosurgery. As part of the Centura Health System, St. Mary-Corwin has immediate access to Flight For Life and St. Anthony’s Level I Trauma Center for consultations and adult transfers. Gunshot wounds and select pediatric cases are typically transferred to Level II or Level I Trauma Centers.

James West, a Pueblo high school soccer player, and his parents are grateful for the quick diagnosis that got West back on the pitch.

INJURY TIME-OUT Head to the ER if you experience one of these lesser-known soccer injuries: INTERNAL/ORGAN LACERATIONS: Internal lacerations caused by trauma to the pancreas, liver, spleen, and other internal organs can be life-threatening.

Any lingering pain, especially atypical pain for the type of injury suspected (e.g., bruise), should be evaluated in the ER.

FACIAL FRACTURES: A Brazilian study finds that facial bone fractures are relatively common soccer injuries and that the time between a facial fracture injury and treatment can range from seven to 33 days — a delay that can lead to significant deformities, as well as chewing and breathing issues. Any signs of pain, swelling, and/or deformity should be evaluated immediately.

St. Mary-Corwin Medical Center is part of the Centura Health Trauma System, the region’s largest and most comprehensive network of trauma care and emergency services.

 St. Mary-Corwin provides ongoing medical education to first responders in our community.

If you are an EMS or EMT professional, go online to get a schedule of upcoming classes at stmarycorwin.org/stc/specialties/emergency-services/education-center. 

stmarycorwin.org • Fall 2015 | cheers

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CONNECTION D

iabetes starts in the pancreas, but its debilitating process can affect many organs, especially the kidneys, if left unchecked. Over time, high blood sugar can damage the tiny blood vessels in the kidneys that filter waste products from the blood.

People with kidney failure need dialysis to take over the job the kidneys are supposed to do, unless or until they get a kidney transplant. A dialysis machine filters extra fluid and waste products from the blood.

But regular blood vessels aren’t strong enough for blood to travel in and out during repeated dialysis. To create better access for dialysis, a vein and an artery can be surgically connected in a procedure called a fistula.

This procedure is now available at St. Mary-Corwin Medical Center.

Access for dialysis

When dialysis was invented, “the idea of getting blood out of somebody and running it through a filter to do the job of the kidneys was a major medical advance,” says Kenneth R. Madsen, MD, director of vascular surgery at St. Mary-Corwin Medical Center.

The first tool to create access for dialysis was lifesaving for people with kidney damage, but it was far from perfect. “An external tube was sewn into the skin, connecting an artery and a vein,” Madsen says. “But

the tubes got infected, they were easily damaged, and sometimes they got pulled out and people bled to death.”

Today’s dialysis machines are very efficient, Madsen says. But the body hasn’t kept up. “The problem remains, how do you get the blood out at a good enough rate to run it efficiently through a machine to filter, and get it back into the patient and keep that flow at a high rate?”

The three main ways to create access for dialysis are as follows: 1. Fistula, a connection between two parts of the body that aren’t usually connected — in this case, a vein and an artery (usually in the forearm) 2. Graft, a connection made with synthetic (man-made) material 3. Catheter, an external tube, usually into a large vein in the neck

Understanding the options

A surgical connection between an artery and a vein, called a fistula, is the best way to create access for dialysis, Madsen says.

A catheter may be used for emergency dialysis or while people are waiting for a fistula or graft to heal, but it’s not a good long-term option for dialysis patients.

“There’s a high rate of infection with catheters,” Madsen

St. Mary-Corwin’s vascular surgery department provides fistula surgery as well as ongoing fistula monitoring and management. Talk to your doctor for more info.

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Procedure to connect a vein and artery makes dialysis safer and easier for patients

Blood sugar on the rise

How a fistula works

A fistula combines the flexibility of a vein with the high blood flow capabilities of an artery. “Veins are very thin-walled, because they are a low-pressure system. They don’t have to be thick-walled and muscular to handle high pressure like arteries do,” Madsen explains.

The flexible vein can adapt and mature into a stronger blood vessel when it is connected to an artery. “It expands and gets full of blood,” Madsen says. “Once there’s high pressure in the vein, it enlarges and thickens up a little.”

It takes about six to eight weeks for an arteriovenous (artery to vein) fistula to heal and mature so it is ready to use for dialysis access.

A blood test called a hemoglobin A1C measures average blood sugar over the past two or three months. “An A1C is like a blood sugar report card — it shows how much sugar is attached to the outside of red blood cells instead of inside where it’s supposed to be,” Schroll explains. “My father died from complications of type 2 diabetes, so I get an A1C every year.”

People at risk for diabetes who should be tested for high blood sugar include:

 People who do not exercise regularly  People who are overweight  African-Americans, Hispanics, Native Americans, AsianAmericans, and Pacific Islanders

 People with a family history of diabetes  Mothers of babies weighing more than 9 pounds at birth, or a history of gestational diabetes  People with polycystic ovarian syndrome  People with high cholesterol, high triglycerides, or high blood pressure Moderate weight loss and increased exercise can help people with prediabetes control their blood sugar and delay or avoid getting diabetes.

 LIVING WELL WITH DIABETES Learn how to prevent diabetes complications. For information about diabetes education and selfmanagement, call 719-557-5955. 

stmarycorwin.org • Fall 2015 | cheers

A report card of risk PHOTOS: PIPE LETTERS ©DOLLARPHOTOCLUB.COM/STEVEYOUNG; SUGAR ©DOLLARPHOTOCLUB.COM/ VJOTOV

says. “They can cause blood clots to form and can cause narrowing and scarring inside the vein.”

With a graft, an artificial tube connects an artery and a vein. It is an alternative for patients whose blood vessels aren’t healthy enough for a fistula procedure, but it has a higher rate of infection and other problems than a fistula.

Connecting an artery directly to a vein creates a fistula, a self-healing “supervein” of sorts that can handle the repeated needle sticks needed for dialysis. “It can actually heal itself because it’s made of tissue,” Madsen says. “Fistulas can be used for dialysis for years and years, and they keep healing themselves right back up.”

When blood sugar is starting to get high, but isn’t high enough to be called diabetes, it is considered prediabetes. By catching people when they have prediabetes, “we can hopefully keep it from going all the way to becoming diabetes,” says Jody Schroll, RN, BSN, diabetes educator at St. Mary-Corwin Medical Center.

Only one in eight people with prediabetes knows they have it, according to a recent study in the American Journal of Preventive Medicine. When people realize they are at risk for diabetes, they are more likely to make healthy lifestyle changes, the study showed.

BE SUGAR SMART

If you’re at risk for diabe tes, call your doctor today to set up a blood sugar test. Visit stmarycor win.org to find a doctor near you.

D IABETES IN OUR NEIGHBORHOOD

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Pueblo has a higher rate of diabetes than the state average: 7.4 percent of adults in Pueblo have been diagnosed with diabetes, compared to the 5.45 percent average in Colorado. 

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ost everyone will experience some type of wound — a scrape or scratch that breaks the skin or body tissue. Yet, estimates show that up to 8 million Americans battle chronic wounds, which are wounds that don’t heal properly or in the expected time frame for the type of wound.

Often, chronic wounds do not receive enough oxygen to heal, like in the case of patients with circulatory problems. To better treat this type of wound, St. Mary-Corwin Medical Center recently expanded its treatment options to include hyperbaric oxygen therapy (HBOT), which uses pressure and pure oxygen to speed healing.

“Hyperbaric therapy provides vast benefits, including helping wounds heal faster by killing bacteria, promoting the growth of blood vessels, and improving the performance of antibiotics,” says Christopher Jeffries, program director at St. Mary-Corwin Wound and Hyperbaric Center.

Among those with chronic wounds, HBOT has been shown to decrease amputation rates while increasing healing rates.

At St. Mary-Corwin Wound and Hyperbaric Center, patients spend roughly 90 minutes a day, five days a week, in a hyperbaric chamber that is pressurized to two or two and a half times that of normal atmospheric pressure and filled with 100 percent oxygen. Some patients require a few weeks of treatment and others a few months, depending on the severity of their wounds, Jeffries says.

HBOT has minimal side effects, with rare occurrences of claustrophobia and/or barotrauma (injuries, typically in the ear, resulting from pressure).

Up to 10 percent of St. Mary-Corwin wound patients could benefit from HBOT, says Patricia Turner, RN, clinical nurse manager at St. Mary-Corwin Wound and Hyperbaric Center.

Who can it help?

Patients who may benefit most from hyperbaric oxygen therapy (HBOT) include those with: Diabetic wounds Skin flaps or grafts that don’t heal well Post-radiation wounds Problem wounds (wounds that don’t respond to antibiotics, standard wound care, and/or surgery) Osteomyelitis (bone infection) Getting healthy skin back is easier and quicker with hyperbaric wound treatment at St. Mary-Corwin.

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 If you have a wound that is

not healing properly, you may be a candidate for hyperbaric therapy. To learn more, call 719-557-5455. 

WARD OFF WOUNDS

Wound prevention can help those most susceptible to chronic wounds reduce their risk. “Early treatment is always better than waiting, no matter what type of wound you have,” says Patricia Turner, RN, clinical nurse manager at St. Mary-Corwin Wound and Hyperbaric Center.

Who: Diabetic patients Why: Diabetes can slow wound healing, and up to 15 percent of diabetic patients develop foot ulcers.

What to do: Check feet regularly, maintain optimal blood sugar control, exercise regularly, and follow your diabetes treatment plan.

Who: Paraplegics and people with limited mobility Why: Limited movement can lead to wounds and hinder oxygen flow, slowing the healing process.

What to do: Move as much as possible and shift weight regularly.

Who: People with peripheral arterial disease (PAD) and ischemia Why: PAD can advance to ischemia, a condition that impedes blood flow to the legs, feet, and hands. This lack of circulation can result in chronic wounds.

What to do: Exercise regularly, maintain a healthy weight and diet, and avoid tobacco use.

PHOTOS: CLOCK ©DOLLARPHOTOCLUB.COM/STILLFX; LEGS ©DOLLARPHOTOCLUB.COM/NOBILIOR

HEALING

Hyperbaric oxygen therapy at St. Mary-Corwin helps wounds heal faster

Making sense of the spots St. Mary-Corwin Medical Center provides expert monitoring and management of lung nodules

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iscovering you have a spot, or nodule, on your lung likely triggers all kinds of emotions.

While more than half of all lung nodules are not cancer, the team of pulmonary experts at St. Mary-Corwin Medical Center’s Lung Nodule Clinic can offer peace of mind by tracking nodules — and, if necessary — treating them.

Sam Widdowson, BSN, MSN, FNP-BC, a thoracic nurse navigator at the clinic, answers common questions.

Q: What is the Lung Nodule Clinic, and who does it help?

A: Housed at Pueblo Pulmonary Associates, the Lung Nodule Clinic evaluates patients who have previously been screened for lung cancer and patients in whom lung nodules are found “incidentally” through a CT scan of the chest or abdomen or X-ray of the chest.

PHOTOS: WIDDOWSON BY STEVE BIGLEY; SCAN ©DOLLARPHOTOCLUB.COM/MACK7777; SMOKING ©DOLLARPHOTOCLUB.COM/MCCARONY

Q: What if cancer is suspected?

A: Both the size of the nodule and the characteristics of the nodule — plus a patient’s risk factors such as family history or smoking — will determine if we move on to further imaging or procedures. If cancer is detected at its earliest, most treatable stages, we will have better treatment options. This is the basis of our entire program. Early detection is key.

Q: If the lung nodule is not cancerous, what then?

A: Many causes exist for lung nodules, including scarring and past pneumonia. In most cases, we will do surveillance of the nodule through repeat CT scans. We take the side of caution, monitoring nodules over time. If the nodule remains stable over time, often nothing more needs to be done.

Q: As a thoracic nurse navigator, what do you do for patients and families?

A: Education is the key component I bring.

I walk them through the whole process, whether the nodule is cancerous or not. I explain what pulmonary nodules are, why we follow them, and how to limit the risk factors — such as smoking or environmental exposures — that might put patients into a higher-risk category.

Lung nodules — whether cancerous or benign — most often do not cause symptoms.

Female smokers more likely to develop cancer Quitting earlier means more time later

Women smokers are 20 percent more likely to develop lung cancer — the leading cause of cancer-related death for both women and men — than in the past, according to a study published in 2013 in the New England Journal of Medicine. Researchers believe that is due to earlier and heavier smoking. But quitting earlier also reaps large rewards, found a second study in the journal. Women who quit by age 34 gain 10 years of life, compared to four years for women who quit later between ages 55-64.

But quitting at any time reaps benefits. In less than one month after quitting, you’ll start to feel your lung function and circulation improving. After about nine months, shortness of breath and coughing will decrease. And after just one year, your risk of heart disease decreases to half that of someone who continues to smoke.

Half of all “spots” on lung images, called nodules, are noncancerous, explains Sam Widdowson (above) with St. Mary-Corwin Medical Center.

T IME TO QUIT Ready to eliminate one of the major risk factors for lung cancer? Our evidencebased, seven-week Freedom From Smoking class can help! For information or to register, call 719-557-5280. 

St. Mary-Corwin Medical Center is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

stmarycorwin.org • Fall 2015 | cheers

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St. Mary-Corwin Medical Center brings specialized care in the complex areas of cancer care, robotic surgery, joint replacement surgery, sports medicine, pediatrics, women’s services, cardiology, and more. We are part of Centura Health, the state’s largest health care network. The purpose of this publication is to support our mission to improve the health of the residents in our community. No information in this publication is meant as a recommendation or as a substitution for your physician’s advice. If you would like to comment on this magazine, please email cheers@centura.org. Cheers is produced by Clementine Health Marketing of Denver, Colo.

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1008 Minnequa Avenue Pueblo, CO 81004

Part of Centura Health, the region’s leading health care network.

Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact Centura Health’s Office of the General Counsel at 303-804-8166. Copyright © Centura Health, 2015.

Events Calendar

Looking for some inspiration or motivation to improve your health? Join the health experts at St. Mary-Corwin Medical Center at a variety of health classes and programs around the community. Here are just a few of the programs we offer. To see more classes, go online to stmarycorwin.org/calendar. Cheers to your health!

FREE

Mon, Oct 12 | 5-7 p.m.

Dorcy Cancer Center Call 719-557-5622 to let us know you are coming. You can also visit us online at stmarycorwin.org/ jointreplacementcenter.

Freedom From FREE Smoking

Starts Wed, Oct 14 | 2-3:30 p.m.

Dorcy Cancer Center Library An effective, evidence-based cessation program with eight classes spanning over seven weeks. Includes a FREE, basic membership to access the Webbased program and is available 24/7 for class participants. To register, call 719-557-5989.

Lung Cancer Support Group Meets the first Wednesday of every month from 5:306:30 p.m. Call 719-557-5989 for location and to register.

Walk With a Doc

Saturdays, Oct 17, Nov 14, Dec 12 | 9 a.m.

FREE Lake Minnequa This is the perfect way to stay active. The walk is FREE and goes around Lake Minnequa with physicians from Southern Colorado Family Medicine. Meet by the Lake Avenue fire station across from St. Mary-Corwin. Participants receive a free T-shirt and pedometer.

Blood Drive

Fri, Dec 11 | 10 a.m.-3 p.m.

St. Mary-Corwin, West FREE tower entrance Save up to three lives with just one donation of blood. To make an appointment, call 719-776-5822.

Walk-ins are also welcome.

STEPPING ON!

FREE Tuesdays, Nov 3-Dec 15 | 9:30-11:30 a.m.

Dorcy Cancer Center, Healing Arts Room Stepping On! empowers older adults to carry out healthy behaviors that reduce the risk of falls. It is a communitybased workshop offered once a week for seven weeks, using adult education and self-efficacy principles. In a small group setting, older adults learn balance exercises and develop specific knowledge and skills to prevent falls. Older adults who should attend are those who are at risk for falling, have a fear of falling, or who have fallen one or more times.

The workshop is co-led by a health care professional and a lay leader. Local guest experts assist by providing information on exercise, vision, safety, and medications. Limited to 14 participants. Call 719-557-3631 to register.

PHOTOS: SMOKING ©DOLLARPHOTOCLUB.COM/WAVEBREAKMEDIAMICRO; HIKE ©DOLLARPHOTOCLUB.COM/AMRIDESIGN

Total Joint Seminar